DENVER -- One in 30 baby boomers is infected with hepatitis C, and most don't even know it, according to a recent alarming statistic released by the Centers for Disease Control and Prevention.

CDC officials say the disease, transmitted through blood, can survive for three weeks on surfaces at room temperature. According to Colorado Department of Public Health and Environment officials, the number of cases in Colorado are increasing as well. Experts worry that baby boomers don't realize they have the disease, which is caused by a virus that attacks the liver. While doctors are trying to get a handle on one epidemic, another is developing that coincides with growing opioid abuse across the country.Kimberley Bossley lost her mom to hepatitis C, but she's beat it too."There's really no words to say in the final hours, it's a painful disease. It's not a way to go,” said Bossley. "At birth, both my mom and I were infected during a blood transfusion, that later we learned in 2005 was tainted with hepatitis C."Before the early 90's, blood supplies in the U.S. were not screened for hepatitis C. That's partly why two thirds of people living with the disease are baby boomers, according to Daniel Shodell, the Medical Director of Disease Control and Environmental Epidemiology with CDHPE. CDC officials also say sharing needles or equipment used to prepare or inject drugs, even if only once in the past, could spread hepatitis C.

"If we can diagnose and treat enough people with hepatitis C, what we are doing in technical terms is reducing the reservoir," said Shodell.Part of the problem is that many people don't show symptoms until the late stages."Maybe 25 percent of people will show symptoms; fever, nausea, vomiting, jaundice, other symptoms, but most won’t know they've acquired hep C."And for years, the treatments were almost unbearable. Bossley tried them until a clinical trial came through. Now there have been major advances made, but still a risk exists and is increasing as more cases pop-up with opioid abuse growing.

Over the past three years, state Medicaid programs have done a much better job of disclosing information about access to expensive hepatitis C medicines and fewer are restricting treatment to patients, according to a new analysis.

In 2014, 12 states did not make public their criteria for treatment, but all 50 states now do so (although one state, New Jersey, does not disclose specifics for treating different stages of the disease). And in the past three years, 17 states dropped restrictions to access based on a patient’s stage of liver disease, which has been a key test for determining treatment. In 2014, all 50 states had restrictions.

Nonetheless, a fair number of states continue to impose various restrictions that impede access to treatment, even though prices for the medicines have started to fall, according to the authors of the analysis1, who argue this violates federal law and runs counter to treatment guidelines and a notice from the Centers for Medicare and Medicaid Services (here is a state-by-state report card.

“There is progress, especially when it comes to restrictions for treating advanced liver disease,” said Robert Greenwald, who heads the Center for Health Law and Policy Innovation of Harvard Law School, which conducted the analysis and has filed lawsuits against two state programs over restrictions. “Over 65 percent of states continue to have liver disease restrictions, and nearly one in four states require patients to have advanced liver disease before treatment. It’s not something to be proud of.”

Two years ago, CMS officials warned state Medicaid programs against “imposing conditions for coverage that may unreasonably restrict access” to hepatitis C drugs. Placing restrictions may be “contrary to the statutory requirements” of a federal law that requires state Medicaid programs to pay for all medically necessary treatments, they wrote.

At the same time, the American Association for the Study for Liver Diseases and the Infectious Diseases Society of America issued guidelines that counseled physicians to “treat all patients as promptly as feasible.” However, the groups acknowledged that physicians may have to take into account the cost of the hepatitis C medicines when deciding whom to treat first.

The issue has gotten the attention of the National Governors Association, which is planning a meeting later this year to explore strategies for lowering costs, notably for hepatitis C drugs. Meanwhile, though, patient advocates are angry that federal and state officials are turning an indifferent eye to a substantial public health problem that will linger for years.

Figures vary, but a study released two years ago by the Milliman consulting firm found that, of the nearly 2.7 million Americans living with hepatitis C, about 457,000, or 17 percent, are on Medicaid. To what extent that subsides is uncertain, but Wall Street analysts, for instance, have noted that a groundswell of people who are infected with the chronic disease have already been treated.

But last week, the AIDS Institute, a non-profit that also focuses on hepatitis C treatments, wrote a letter8 to CMS officials and urged them to enforce the 2015 state notice and prevent state Medicaid programs from restricting access. One point the group makes is that there is a “misconception” about pricing, since at least one newer drug carries a much lower list price, which should ease the strain on state budgets.The “continued false statements about the price of the cure and its impact on their budgets inject untruths into the debate on drug pricing, while distracting from the fact that people who need treatment are being kept from it,” the AIDS Institute wrote. “If state Medicaid programs want to save money, increasing restrictions is not the answer,” since prices are starting to fall.

The drug, called Mavyret, is sold by AbbVie (ABBV10) and carries a $26,400 list price. This is well below the $84,000 price tag for Sovaldi, a Gilead Sciences (GILD11) drug that was the first in the new generation of hepatitis C medicines. At the time the $1,000-a-day pill was launched nearly four years ago, the cost alarmed private and public payers, since the high cure rate triggered a wave of people seeking treatment.Despite arguments that the newest medicines — Gilead subsequently sold Harvoni, and AbbVie also debuted Viekira Pak — would lower long-term health care costs, the near-term expense for treating a surge of people quickly strained budgets. Many state Medicaid directors responded by implementing restrictions12 which, in turn, prompted the CMS warning and, later, lawsuits against a few states.

WNYC NewsOct 10, 2017 · by Audrey Quinn and Aneri PattaniWhen doctors told Tina Harris that she was infected with hepatitis C, she didn’t know what to think. Other than the few commercials she’d seen on TV, Harris said she hadn’t heard much about the disease.The 52-year-old works at a church in the Bedford Stuyvesant neighborhood of Brooklyn. She said she never used intravenous needles or had a blood transfusion – common means of transmission for hepatitis C. “I don’t know where it came from,” she said.And she may never have found that she was infected if it weren’t for a New York state law that makes hepatitis C screening a required part of primary care for baby boomers. That law led Harris to be tested a few years ago and prompted her to seek treatment. The measure, which the state legislature passed in 2014, was the first of its kind in the U.S. It required health-care providers to test anybody born between 1945 and 1965 for hepatitis C. Now a new study conducted by the New York State Department of Health suggests it might be paying off.The study found that 50 percent more patients were tested in the year following the law’s implementation. The data also showed that about 40 percent more of the patients diagnosed with hepatitis C – like Harris – received follow up care that year. “I would have never asked to be tested,” Harris said.That’s a pretty common mindset among baby boomers, said Kathleen Bernock, a family nurse practitioner and clinical director of the hepatitis C program at Bedford-Stuyvesant Family Health Center. They’re at a stage in their lives where they typically don’t engage in behaviors that would put them at risk, she said. Harris, who Bernock has been treating since her diagnosis, is an apt example.“She is a full-time working woman,” Bernock said. “She goes to church every Sunday. She has her family. She has absolutely no current risk factors for having hepatitis C.”Bernock added: “I think it could very easily have been overlooked if there hadn’t been a mandate in place.” Hepatitis C is a contagious disease that can lead to severe liver damage and sometimes death. About 3 million Americans – most of them baby boomers – have chronic hepatitis C, according to the federal Centers for Disease Control and Prevention. City data show that in New York the number is nearly 150,000 residents. But researchers say the total is likely higher primarily because as many as 75 percent of people who are infected don’t know it, according to the CDC.The disease is typically spread by blood contact from sharing needles to inject drugs, for example, or from having undergone blood transfusions before 1992. That’s when sensitive tests for hepatitis C were introduced for blood screening. All of which means baby boomers are at an increased risk. In fact, baby boomers are five times more likely than any other generation to have hepatitis C, the CDC says. It’s why it’s so important for them to be tested, Bernock said.By the time Harris was screened a few years ago, the disease had already damaged her liver. She had to start a regular course of medication, have blood drawn every two weeks and attend counseling to understand the implications of the disease.Her treatment was covered by insurance. Not everyone is so lucky. A standard 12-week course of hepatitis C drugs can cost up to $90,000. In August, the federal Food and Drug Administration approved Mavyret, a new drug with a lower price tag and a shorter treatment period: about $26,000 for an 8-week course. That can still put the drug out of reach for patients.New York state’s Medicaid program lifts the burden for some. In the third quarter of 2015, the state spent at least $107 million on hepatitis C drugs, accounting for roughly 10 percent of all Medicaid drug spending, POLITICO reported.

TO CONTINUE READING:http://www.wnyc.org/story/new-yorks-unusual-law-is-boosting-hepatitis-c-testing/

The bodies turn up in public restrooms, in parks and under bridges, skin tone ashen or shades of blue. The deceased can go undiscovered, sometimes for hours, or days if they were alone when they injected heroin and overdosed.Terrell Jones, a longtime resident of the Bronx, was pointing to the locations where overdoses occurred as he drove through the East Tremont neighborhood, the car passing small convenience stores, rowhouses and schools.“This is sometimes where people are being found, in their houses, dead,” said Mr. Jones, 61, looking toward a housing project along 180th Street. “Especially in the South Bronx, you have so many people in housing who overdose. To actually sit there and witness this whole thing? You’re watching this person turn all different colors. You know what I’m saying?”The dramatic rise in opioid-related deaths has devastated communities around the United States in recent years, and has stirred concern among law enforcement and public health officials alike in New York City.PhotoTerrell Jones, left, and his colleagues at the New York Harm Reduction Educators hand out information about opioid deaths, offer free naloxone, and operate a syringe exchange program.Here, the reports about the epidemic and its ravages have mostly centered on Staten Island, where the rate of deaths per person is the highest of the five boroughs. But perhaps nowhere in the city has the trajectory of opioid addiction been as complex as in the Bronx, where overdose deaths were declining until a new surge began at the turn of the decade, and where more residents are lost to overdoses than anywhere else in the city. On Bronx streets, the epidemic’s devastation is next door, down the street, all around.

The increase in deaths — now at the highest levels since the city began collecting the data in 2000 — has been fueled by social forces that have left some Bronx residents especially vulnerable: a history of high drug use in the area; a growing supply of cheap heroin on the streets; and the proliferation of a deadly synthetic opioid, fentanyl.Mr. Jones said he never leaves his apartment in Hunts Point without a dose of naloxone, a medication that can be used to reverse opioid overdoses. The antidote — whose brand name is Narcan — has become a necessary stopgap to prevent deaths that happen in public spaces. Mr. Jones, who has himself struggled with drug addiction in the past, now works with New York Harm Reduction Educators to help drug users.“Regardless of how they died, it wasn’t an intentional death. Nobody woke up and said, ‘Today I want to die of an overdose,’” he said. “People have issues and reasons they’re using drugs, and it’s not for us to judge.”

PhotoThree hundred and eight Bronx residents died of drug overdoses in 2016. That’s more than double its 2010 total of 128.In 2016, 1,374 people died from overdoses in New York City, up from 937 in 2015, according to the New York City Office of Chief Medical Examiner. The vast majority of those lethal overdoses involved opioids, a drug classification comprising prescription painkillers like Oxycodone and Percocet, morphine, and the illegal street counterpart, heroin. An additional 344 overdose deaths were reported across the city from January to March of this year, according to preliminary data made available by the New York City Health Department.More Bronx residents died of drug overdoses in 2016 than any other New York City borough — 308. That’s more than double the number in 2010, 128. Fatal overdoses in the borough are now at their highest rates since at least 2000, as far back as official data is available. Eighty-five percent of those deaths involved opioids, and about 76 percent involved heroin or fentanyl specifically.Of the five neighborhoods with the highest opioid-related overdose rates in 2015 and 2016, four were in the Bronx — Hunts Point-Mott Haven, Crotona-Tremont, High Bridge-Morrisania and Fordham-Bronx Park — and one was in Staten Island, South Beach/Tottenville.The crisis in the Bronx stems, at least in part, from a surge of opioids in a place where some residents have long struggled with addiction. Heroin has become much cheaper in recent years as the supply in the United States has grown, according to the Office of the Special Narcotics Prosecutor for the City of New York, and individuals with histories of drug abuse are particularly vulnerable to relapse amid a surge of cheap drugs. It has also become significantly more potent.The cheaper, stronger heroin has been made even more dangerous by the proliferation of fentanyl, which is 50 times more powerful than heroin. Interviews with nearly 200 drug users conducted by the city health department suggest that most users are not directly seeking fentanyl; narcotics experts say the drug is likely being mixed into heroin batches, often without the dealers themselves knowing, let alone users. As effective as naloxone can be in reversing overdoses and restoring breathing, fentanyl overdoses are often too extreme for the antidote to work. And naloxone is ultimately a Band-Aid to a broader, systemic addiction crisis across the city.

TO CONTINUE STORY:​https://www.nytimes.com/2017/10/12/nyregion/bronx-heroin-fentanyl-opioid-overdoses.html?ref=todayspaper

​People with HIV/hepatitis C virus (HCV) co-infection are between a quarter and a third more likely to develop cardiovascular disease compared to people of a similar age with HIV mono-infection, according to the results of a meta-analysis published in the Journal of Viral Hepatitis. Co-infection increased the risk of stroke by 24% and the risk of heart attack by 33%.“In this meta-analysis of 33,723 participants from four cohort studies, HIV/HCV coinfection was associated with a 24%-33% increased risk of CVD [cardiovascular disease] compared to HIV monoinfection,” write the investigators. ‘In coinfected individuals, it has been postulated that both viruses may act synergistically through persistent inflammatory responses to increase the risk of CVD.”There is a well-established link between HIV infection and CVD, with research suggesting that the risk is increased by as much as 61% compared to HIV-negative individuals. People with HCV also have an increased risk of developing CVD. It has therefore been suggested that HIV and HCV have the potential to act synergistically and increase the risk of CVD in individuals with co-infection. Studies examining whether this is the case have yielded conflicting results. To clarify this question, investigators in the United States performed a meta-analysis of studies examining the risk of CVD in adults with HIV/HCV co-infection compared to people with HIV mono-infection. Risk of CVD – coronary heart disease, congestive heart failure and stroke – was adjusted for traditional risk factors including sex, smoking, blood pressure, diabetes and LDL cholesterol.Four cohort studies (two prospective, two retrospective) met the inclusion criteria. A total of 33,723 were included in the analysis. The majority were men and mean age varied between 36 and 48 years. Average follow-up was between 2.3 and 7.3 years. The studies were conducted in the United States, Canada and Spain.

Opioid addiction has developed such a powerful grip on Americans that some scientists have blamed it for lowering our life expectancy.Drug overdoses, nearly two-thirds of them from prescription opioids, heroin and synthetic opioids, killed some 64,000 Americans last year, over 20 percent more than in 2015. That is also more than double the number in 2005, and nearly quadruple the number in 2000, when accidental falls killed more Americans than opioid overdoses.The President’s Commission on Combating Drug Addiction and the Opioid Crisis said in July that its “first and most urgent recommendation” was for President Trump to declare a national emergency, to free up emergency funds for the crisis and “awaken every American to this simple fact: If this scourge has not found you or your family yet, without bold action by everyone, it soon will.” The commission’s final report is due out in a month.Mr. Trump has not declared an emergency, and “bold” would not describe the steps the White House has taken so far. The president’s 2018 budget request increases addiction treatment funding by less than 2 percent, even including $500 million already appropriated by Congress in 2016 under the 21st Century Cures Act.Families across the United States are demanding that more be done to end the despair and devastation of addiction. Here are eight steps to take — now. They include some of the recommendations of the president’s commission.Douglas Brockway 8 minutes ago In the program laid out only two items, the last two, make any direct attempt at avoiding or preventing opioid addiction in the first place...Robert 9 minutes agoI'm concerned that in addition to an opioid crisis there can be an opioid scare crisis. For instance this article sites an instance of...peter bailey 11 minutes ago Our health care system is in crisis. Most entities (e.g. insurance and pharmaceutical companies, hospital systems) are focused on maximizing...

SAVE LIVES Active users need to be kept alive long enough to seek treatment. First responders and emergency rooms lack adequate supplies of naloxone, the medication that can save someone who has overdosed on opioids, particularly fentanyl, a drug so toxic it requires multiple doses of naloxone to reverse. Both federal and state health agencies can negotiate lower prices and expand access to naloxone, and provide encouragement to the pharmacies that are already offering it prescription-free in many states. Congress can help by passing legislation to protect the responders who administer naloxone from liability. The government also needs to spend more on needle exchange and clean syringe programs to combat the infectious diseases that are associated with sharing needles.TREAT, DON’T ARREST Nearly 300 law enforcement agencies in 31 states now participate in the Police Assisted Addiction and Recovery Initiative, which offers treatment for drug users who ask the authorities for help, an approach inspired by a program established in Gloucester, Mass. Officers work the phones to get addicts into treatment and recovery networks, in an effort that costs less and promises more lasting results than repeatedly arresting them.FUND TREATMENT Repealing Obamacare would eliminate Medicaid-funded treatment for thousands of addicts. Republicans need to stop trying to kill the legislation and instead urge more states to adopt its Medicaid expansion, which has helped save lives in the states worst affected by the opioid crisis.COMBAT STIGMA Misunderstanding of opioid addiction shrouds nearly every effort to reduce its toll. To help Americans — and even some physicians — appreciate the crisis, Dr. Kelly Clark, addiction psychiatrist and president of the American Society of Addiction Medicine, is calling for an effort like that used by the federal Centers for Disease Control and Prevention to fight AIDS. In the 1980s, the agency sent a brochure, “Understanding AIDS,” to every residential mailing address in the United States to dispel myths and help Americans seeking treatment. Right now, addiction medicine is a desperately needed but relatively low-status specialty. The federal government could provide tuition incentives for medical students to enter addiction-related specialties and work in underserved communities.SUPPORT MEDICATION-ASSISTED TREATMENT One of the most effective methods of treating drug addiction is through continuing medication therapies like methadone, naltrexone and buprenorphine. Multiple studies suggest these medications help guard against relapse as well as addiction-related medical problems, allowing people to return to work and rebuild their lives. Yet fewer than a third of conventional drug treatment centers in the United States take this approach. Instead, mental health agencies place the poor in ineffective, short-term programs with no follow-up. Some halfway houses and work programs reject people on methadone or other medication-assisted treatments, saying they aren’t “recovered”; people struggling with addiction can be vulnerable to quack “cures” or exorbitant “detox” rehab stays, as can members of their families (who often foot the bills). The federal government can encourage broader acceptance of this treatment by requiring that staff physicians, physician assistants and nurse practitioners in Veterans Health Administration hospitals and federally qualified health centers receive training; that Medicaid and Medicare expand coverage of continuing medication treatment; and that medication options approved by the Food and Drug Administration be available at treatment centers that receive federal funding.​ENFORCE MENTAL HEALTH PARITY Half to 70 percent of people with substance abuse problems also suffer from depression, post-traumatic stress or other mental health disorders, John Renner, president of the American Academy of Addiction Psychiatry, told the president’s commission in June. The Mental Health Parity and Addiction Equity Act of 2008 prohibits insurers that cover behavioral health from providing less-favorable benefits for mental health and addiction treatment than they offer for other medical therapies or surgery. Some insurers defy the law, imposing arbitrary treatment limits or onerous authorization requirements. The federal government needs to strictly enforce the mental health parity law, a job now left largely to the states, and educate Americans about their legal rights in dealing with insurers that cheat.TEACH PAIN MANAGEMENT The opioid crisis is rooted in our health care system: American physicians prescribe opioids for pain management at far higher rates than physicians prescribe them in any other nation. Addiction to those drugs can lead to the use of heroin and fentanyl when prescriptions run out. In California, a recent investigation by The Sacramento Bee found at least five counties in which there were more prescriptions filled for opioid painkillers last year than there were people. In Massachusetts, the state worked with dental and medical schools to ensure that all students received training in the management of prescription opioids and prevention of their misuse. The federal Department of Education could make this a national requirement for all medical students. Meanwhile, states and the federal government must continue to pursue legal action against the drugmakers whose irresponsible practices laid the foundation for this crisis.START YOUNG WITH PREVENTION A 2015 study by the National Institute on Drug Abuse found that “Life Skills Training” for seventh graders helped them avoid misusing prescription opioids throughout their teenage years. Research suggests that life skills programs work better than traditional antidrug abuse lectures by strengthening children’s self-esteem, decision making and communication skills. In Kentucky, a state with one of the highest opioid death rates, health officials point to programs like Metamorphosis, in which counselors work with kids outdoors, using the life cycle of the Monarch butterfly to discuss choices children face as they mature.146COMMENTSThis is by no means an exhaustive list. Strategies like “recovery high schools” for at-risk adolescents, safe injection sites and whole-family treatment programs are still being studied and debated. But the path to a national recovery from the deadliest health crisis in recent history exists.TO CONTINUE READING: https://www.nytimes.com/2017/09/30/opinion/opioid-addiction-treatment-program.html?emc=edit_th_201710